This Performance Improvement 2007 report provides a brief summary of each of the evaluations completed by the Health and Human Services (HHS) during Fiscal Year 2006 (October 1, 2005 to September 30, 2006). All Performance Improvement reports, the full database of summaries or abstracts of the more than 8,000 current, ongoing, and past studies, and links to the full reports produced by these studies are available at http://aspe.hhs.gov/pic/performance.

Evaluation is essential to successful operation of Federal programs. HHS administers over 330 programs (see them all in the Catalog of Federal Domestic Assistance, www.cfda.gov). In FY 2006, HHS spent $613 billion on these programs. That amount included over $800 million provided through the Evaluation Set-Aside provision of the Public Health Service Act (Section 241) as well as other program funds directed to evaluation activities. The Set-Aside provision allows the Secretary of HHS to use a portion of the amounts appropriated for programs authorized under the Act for the evaluation (directly, or by grants and contracts) of the implementation and effectiveness of these programs. Additionally, Congress annually appropriates program funds for both targeted and broad evaluation activities.

Under Section 241 of the Public Health Service Act, annually about 2.4% of funds appropriated under the Act are used both to conduct evaluations and to fund other activities identified by Congress. The Public Health Service Act also requires that the Secretary report annually, to the Senate Health, Labor and Pensions Committee and the House Energy and Commerce Committee, the findings of evaluations conducted by HHS. This report, the 13th in this series, provides summaries of recently completed studies funded with set-aside or other program evaluation funds.

Successful program evaluations increase the likelihood of effective delivery of public services through these programs and ensure that programs are efficient, targeted to their intended clients, and well managed. Important questions addressed by program evaluations include: what are the circumstances in which programs exist, who are the people that need services; and which program activities “work.” The initial needs that give rise to programs, the knowledge base on which they are constructed, and the environment in which they operate, are not static. Actions by various groups and individuals and demographic, economic, political, and social conditions change constantly. For programs to be successful, they must stay abreast of these changes, expect new requirements, and support analytical, management, and policy decision-making. Congress and the President are ultimately responsible for the design, modification and implementation of laws and rules governing programs and both branches of government need the results of ongoing research, program evaluation, and policy studies to effectively monitor and appropriately modify programs when necessary.

In order to make the information that this report contains more fully accessible, and the importance of these studies more readily apparent, this report has two important features. First, each study is identified with a title that seeks to capture the central question that prompted the study so that a reader can quickly identify areas of possible interest. Second, the summary of each study provides a brief action narrative describing the research activity itself. The summaries use a minimum of jargon and acronyms, are written in everyday language, and seek to make this information available to a broad readership of interested individuals. The summaries are brief synopses of what the studies were about and why they were conducted, with examples of significant lessons learned, facts gathered, and recommendations made by the investigators. These summaries are intended to provide accomplished experts, proficient novices and the general public a source of interesting factual information and signposts to valuable research.

Structure of this Report

Evaluations summarized in this year’s report are organized under the Department of Health and Human Services’ Fiscal Year 2004-2009 Strategic Goals and Objectives addressing the following eight broad areas:

Preventing Disease and Illness

Protecting Our Homeland

Closing the Gaps in Health Care

Improving Health Science

Realizing the Possibilities of 21st Century Health Care

Working Toward Independence

Leaving No Child Behind

Improving Department Management

Chapter 1 highlights major themes and provides examples of interesting findings emerging from the completed studies. Chapter 2 provides the individual summaries of all the studies. Chapter 3 describes the Department’s evaluation responsibilities and offers a conceptual framework of the role of evaluation. Appendix A contains the full set of the Strategic Goals and Objectives introduced above. Appendix B contains statements of each agency’s mission and evaluation program. Appendix C provides a table of the studies by each agency and the Objective in this report where the study may be found.

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